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目的:探讨血管紧张素II受体拮抗剂(ARB)坎地沙坦治疗充血性心力衰竭(CHF)时对外周血中利钾尿肽(KP)、心房钠尿肽(ANP)和内皮素(ET)水平的影响。方法:94例老年CHF患者随机分为常规治疗组(硝酸酯类药物+利尿剂+地高辛)和坎地沙坦组(常规治疗药物+坎地沙坦),随访12周,采用放射免疫分析方法测定两组治疗前后和34例健康者(正常对照组)外周血浆中KP、ANP和ET水平。同时用核素心室显像测定CHF患者左心室射血分数(LVEF)。结果:CHF患者的血浆KP、ANP和ET水平较正常对照组显著升高,随着病情的好转其水平逐渐降低,且不同的心功能分级之间有显著差异(P<0.05)。治疗后,坎地沙坦组外周血中KP、ANP和ET水平较常规治疗组下降更显著。结论:坎地沙坦有抑制CHF患者神经内分泌的过度激活和肾素-血管紧张素-醛固酮(RAAS)系统亢进的作用。
Objective: To investigate the effects of candesartan, an angiotensin II receptor antagonist (ARB), on the expression of kallikrein (KP), atrial natriuretic peptide (ANP) and endothelin (ET) in peripheral blood in patients with congestive heart failure ET) levels. Methods: A total of 94 senile CHF patients were randomly divided into routine treatment group (nitrates + diuretics + digoxin) and candesartan group (conventional treatment + candesartan), followed up for 12 weeks by radioimmunoassay The levels of KP, ANP and ET in the peripheral blood of the two groups before and after treatment and 34 healthy controls (normal control group) were determined by the method of analysis. Simultaneous determination of left ventricular ejection fraction (LVEF) in CHF patients by radionuclide ventriculography. Results: The levels of plasma KP, ANP and ET in CHF patients were significantly higher than those in normal controls. The level of KP, ANP and ET in patients with CHF gradually decreased as the disease progressed. There was significant difference between different grades of cardiac function (P <0.05). After treatment, the levels of KP, ANP and ET in the candesartan group decreased more significantly than those in the conventional treatment group. CONCLUSION: Candesartan inhibits over-activation of neuroendocrine and hyperthyroidism of the renin-angiotensin-aldosterone (RAAS) system in CHF patients.